Letter from a non-executive director to the Chairman and Chief Executive of WMAS Trust - Questions were asked 22nd June 2007. After much chasing up, the non-executive director received his reply 1st August 2007, control staff 2nd August. Text in black is of points raised by control staff with the non-executive director. Responses in blue are from the Chief Executive. Text in red indicates a response from H + W EOC. No apology has been offered for the lateness of these replies, which were promised within 1 week of 25th June 2007
 
We had a very good H&W Performance and Governance meeting today and following this meeting I spent about 45 minutes with the Call Centre staff.  I wanted to share their feedback with you prior to Monday’s meeting.  The staff were clearly upset about the proposed closure of Brandsford and were not frightened to voice their opinions.  Many of them plan to attend Monday’s meeting, which I feel is positive.  It is also clear that they are passionate about what they do and very concerned about patient safety.  The key messages I captured (in no particular order of priority) were as follows: -

The impacts on the Bransford PTS operation had been totally forgotten/ignored in the consultation and briefing documents.

The Bransford PTS operation has been examined and will be taken into account. We are recruiting a Regional Head of Non-Emergency Transport Services.

This still doesn't spell out to PTS what is happening to them. Can only deduce PTS dept was completely overlooked, there is still no answer to the issue other than to recruit someone to deal with the problem as an afterthought.


They believe they are highly skilled at what they do and multi task as opposed to the battery hen run approach in Millennium Point.  In summary they feel their jobs are more complex, interesting and rewarding than their counterparts in Millennium Point.

All EOC staff are worthy of the same mutual admiration and respect and to say otherwise, I believe is unfair and unjust. No one-person’s duties should be classed as more important than the others, as everyone has a vital role to play within our organization.

Failure to address the point in question.

Millennium Point went down last week during the floods/storms whereas Bransford was not impacted.  Patient risks will be higher in future if this happens again.

The recent flooding of the BT exchange at Brierley Hill gives a very graphic example of the benefits of a centre such as the one at Millennium Point. Had the situation happened at Bransford, the EOC there would undoubtedly have been unable to continue and staff would have had to have been moved to Bromsgrove resulting in a period without 999 calls being answered or vehicles despatched within the Locality. No calls were lost at Brierley Hill in contrast to Shrewsbury, who had to write calls on paper for 24 hours. In relation to fall back facilities, it is widely accepted that the fall back facility is no longer fit for purpose and would require a very significant upgrade to bring it up to date. We will enjoy the benefit of a second regional operations centre at Stafford, which will create our ‘virtual’ control room scenario.

Weeks later the Herefordshire and Worcestershire area suffered its worst flooding in decades. There was no loss of any system at H + W Ambulance Control. WMAS have claimed Bransford was within minutes of being evacuated. There was no indication anything of the sort was in the offing. Moreover, it would have been a pointless excercise as the control was never under threat. It was Sunday afternoon before the Associate Director of Performance Improvement arrived At H + W Ambulance control by which time the Worcester floods were well over their worst. WMAS CAD system appeared to fail staff working in Millennium Point control room the 1st day of the floods. We're being told this was a deliberate shut-down for maintenancerather than failure. If this is the case then it indicates a monumental lack judgement. Why would anyone with a grain of common sense wait until the worst weather in decades is forecast and then shut the system down that day? It appears the system also failed over the weekend of 5th August - or was this another planned shutdown? If so, why was one needed so hot upon the heels of the previous one?

They have received high national performance ratings and recognised as a high performing call centre.

The following figures are year to date up until the end of June. As you can see BBC is currently ahead in all three of Key Performance Indicators – Cat A8, A19 and B19. Shropshire figures are lower than that of BBC, which will in turn affect a combined Hereford, Shropshire and Worcester Locality. You are quite right that H&W leads the way in regard to Referrals right across the Region. I do not believe that this is what was being suggested on the website. It is of course noteworthy that the H&W Locality is meeting all of the KPIs.


Category                     Period               H&W        C&W       BBC&S
Cat A (8 Minutes)        Year to Date      79.1%       84.1%     82.2%
Cat A (19 Minutes)      Year to Date      96.8%       88.0%     99.7%
Cat B (19 Minutes)      Year to Date      95.6%       97.1%     96.7%
Doctors Referrals        Year to Date      99.6%       97.2%     96.2%

To borrow a WMAS Trust Board line......evidence please of whatever it is you're trying to say.

BBC is not ahead as there are no standalone figures for the BBC. BBC and SHROPSHIRE are ahead in the Cat A + B performance. Shropshire must be peeved at being dismissed as of no account in this way. Similarly there are no standalone Shropshire figures so what is meant by Shropshire figures being lower than that of BBC? It should also be noted Hereford and Worcester EOC has been understaffed since January 2007 due to a recruitment freeze imposed by West Midlands Ambulance Service management.

http://news.bbc.co.uk/1/hi/england/west_midlands/6043132.stm dated 12 October 2006:
The West Midlands Ambulance Service and two Black Country primary care trusts were labelled weak in both areas, making them among the country's worst.
The Black Country appears the worst place to live in the region for health services as it is served by West Midlands Ambulance Service, Rowley Regis Primary Care Trust (PCT) and Oldbury and Smethwick PCT, which were all rated weak in both areas
The four ambulance trusts, which are due to merge to form a region-wide service, were given mixed ratings. While the West Midlands, which also covers Shropshire, scored badly, Coventry and Warwickshire and Hereford and Worcester both provide a good quality of service.
However, Staffordshire Ambulance Trust, which won a temporary reprieve from merging after it fought a campaign saying it would adversely affect its service, was rated as weak for its quality of service in the report.

They believe their skills, local knowledge combined with many years of service gives them a unique advantage in providing an excellent service to the citizens of Herefordshire and Worcestershire.

Their local knowledge and many years of service can be transferred to another EOC in order they can continue to provide an excellent service to the people of Hereford and Worcester. Local knowledge will also be retained by local crews who will not change, which will be combined with better technology.

This is pure speculation. Perhaps not a single H + W Ambulance Control employee will choose to accept employment at Millennium Point. (See point 13.) This is obviously what is meant by "can be transferred", rather than "will be transferred". You can't guarantee now, or in the future, that crews will always be in locations known to them. Currently, our crews in our area have local knowledge via ambulance control even if they don't have it themselves on account of responding to a location off their usual patch.

They feel the consultation process is a charade/sham and that the decision is already made.

This is simply not true. We take very seriously all views from stakeholders and if there are any better proposals for EOC Reconfiguration and no decision will be taken until the end of the 3-month consultation period. The Trust welcomes a debate about the future of EOCs; you will recall my pledge that if anyone can come up with a better solution that meets the needs of the Trust, the Board will be happy to examine it in detail.

It's not a task for members of the public to submit solutions in finite detail. Surely it is the remit of WMAS Trust Board to provide more than one solution. Better solutions have now been submitted. WMAS Trust now need to examine these suggestions and present an accurate business case for each. Can all interested parties be assured all proposals submitted are being consulted upon?

They expressed concerns about the traffic issues with regard to working at Millennium Point (MP), particularly in the October – January timeframe, i.e. MP is difficult to get to.

There is no evidence to suggest this as staff that may reside in Kidderminster and Redditch would live nearer to Millennium Point compared to Bransford.

One staff member lives at Kidderminster out of the 28 in ambulance control. None live in Redditch. Ample evidence. 27 or even 28 people will be disadvantaged by having to commute to Brierley Hill. Living closer to Brierley Hill than Bransford has no guarantee of it being an easier journey. The point about traffic being worse over the Christmas shopping and sales periods has been missed completely.

Parking is constrained at MP and they cannot afford to pay for parking.

Staff parking is available at Millennium Point with other parking available nearby.

No spaces left. Every time any Hereford and Worcetser personnel visit MP they have to park in Royal Mail carparking spaces. This will only get worse if the headcount at MP is increased.

They are very concerned about being made redundant despite the assurances in the consultation papers.

There will be no redundancies. The trust is committed to finding jobs for everyone who might be affected by any forthcoming change. This might mean working at one of the other EOCs in the region, but could result in staff moving in operational road crew positions.

There are no redundancies even for the people that would positively welcome them. This could be construed as constructive dismissal if the alternative posts offered simply aren't suitable. These alternative posts would also erode the transfer of local knowledge to MP control room.

The people who wrote the consultation paper do not understand what goes on in the control centre at Bransford.

The Department of health (DH) commissioned a report into Control Rooms within the English ambulance Services, which makes recommendations, offers advice and sets out the minimum requirements for Control Rooms. Local work has also been carried out examining the systems that are currently in place. The DH also visited the West Midlands during its research. What evidence do you have to support your claim?

Which location in the West Midlands did DOH visit?Staff at H + W ambulance control firmly believe "The people who wrote the consultation paper do not understand what goes on in the control centre at Bransford." The Trust Board has done nothing to address this. Your statement yet again fails to answer the question that has been asked. For evidence, simply ask the staff.


They believe everything is driven by money as opposed to patient care.

The amount of money being invested in EOCs has never been higher and is continuing to grow. Any money saved would be re-invested in the other EOCs so there is no cost saving involved; it is purely about improving the service to patients as well as improving the resilience of the Control Centres.

This directly contradicts a written statement from WMAS Press Office and again in point 19 below,
quote,

"The Trust would also be able to save over £500,000 by not having to upgrade the equipment and make building changes to the current Bransford site thus providing this investment to improve front line operations e.g. paramedics and ECPs."


The Ambulance Service is not a business it’s about saving lives!

The Ambulance is about saving lives and by making these changes; we can invest the money saved into better staffed, more resilient and ‘fit for future purpose’ EOCs, having a direct impact on saving even more lives.

Only if you live in Birmingham Black Country arther than Herefordhire, Worcestershire or Shropshire. Robbing Peter to save Paul.

Relocation would not be feasible for everyone.

We will discuss on an individual basis where we can assist each member of staff to relocate or pursue an alternative post in the Trust.

Yet you still insist local knowledge will not be affected.

What job opportunities and retraining would be offered to them working in their current location?

As I have stated previously, staff that do not wish to transfer will be given the opportunity to retrain as operational road crews or backroom functions. We will provide tailored support appropriate to each member of staff.

Yet you still insist local knowledge will not be affected.

Not all of them want other opportunities, i.e. they joined the service to work in the emergency operations centre and they see their roles as critical to saving patients lives, i.e. it is a job they enjoy and want to continue to do.

Staff will continue to be able to work in an EOC of their choice should they choose to do so.

For Hereford + Worcester employees, Bransford is their EOC of choice. If, after consultation, the decision is still made to close Bransford, WMAS senior management would find themselves unable to deal with the situation if all Bransford employees chose to work at Leamington Spa.  No seat/desk space, no carparking.  Another example of complete failure to recognise the repurcussions both of closing Bransford and in coming up with an entirely non-viable "solution".

Even if staff are redeployed, these skills will be lost over time, so again patients will be put at risk.

The skills will not be lost but transferred to new staff as they join our organization as happens now at Bransford and all our EOCs. There is no evidence to suggest that patients are put at risk. The overall contingency arrangements will be much safer than is currently the case.

In closing Bransford ambulance control you run the risk of losing more staff in one fell swoop than would ordinarily occur in years. The impact of theis wholsale loss of experience cannot be underestimated. How do you propose to manage this?

They kept on re-enforcing the point about local and geographic knowledge and how they have to help other bordering districts out.  In addition they also quoted examples of where significant delays had been incurred, e.g. bordering services did not have the knowledge to despatch the vehicles promptly to the incident, e.g. their colleagues were not very good at determining which vehicles were closest in the case of some cross border activities/incidents.

There have also been instances of delays where operation procedures have not been adhered to in respect of Shrewsbury and Bransford EOCs. This has put lives at risk and an internal investigation is underway. A Shropshire Member of Parliament brought this incident to our attention. The improved CAD system, digital radio system and date will support these improvements.

No other CAD system in operation is as good as H + W's MIS system. Therefore even an improvement on the current BBC CAD system, will still fall short of the performance of the MIS system.

Terrorist threats, etc. provide a greater threat to Birmingham/MP, so why close Bransford, shouldn’t you consider expanding it?

In regard to the question of how a large centre can be more resilient, the details are listed in the consultation document. Under the proposals, all three EOCs would be operating as one virtual centre. In the unlikely event that one of the centres suffered a catastrophic failure; the other two would automatically sustain a safe and robust 999 services. At present, H&W would be without a service for 30 minutes or more.

This is the 2nd time WMAS Trust Board has avoided directly answering this question. The proposals document states over and over that a large centre is more resilient without explaining how. As requested on a previous occasion, please state in simple terms that we can all understand, how reducing the number of EOCs makes the Service more resilient? Were investment to be made in all 5 EOCs you’d have all the advatages of a virtual control centre plus all the advantages of strategically located EOCs.

If you’re striving towards a virtual control centre why does it have to have limited locations? Limiting the locations allows vast sums of capital to be realeased in the form of sale of Bransford and part sale of ShrewsburyPlease evidence how a large call centre can be more resilient
WMAS are very good at making a statement and expecting it to be believed when it makes no sense and has no evidence to support it.

Again you're not comparing like with like. You say that under the proposals all three EOCs will operate as one virtual centre but that is not the case now. You then say at present H + W would be without a service for 30 minutes or more. You're comparing "proposed" in one instance with "at present" in the other. Please be consistent. Why can't under the proposals all 5 EOCs work as one virtual centre?

Why are we retaining Leamington as opposed to Brandsford or Shrewsbury?

If the only advantage that Bransford has is to have space available, then this is not a strong enough case for its retention.

This is the same feeble reply as last time this question was asked. The reappearance of this answer is evidence that you have entirely failed to recognise points brought to your attention previously. To restate -

Unlike both Leamington Spa and Millennium Point, there’s also extensive car parking - 42 spaces and room for more. Another advantage is that the property’s owned outright and therefore not subject to tenancy restrictions. But perhaps it’s biggest asset is its location. Birmingham is a prime terrorist target, probably second only to London. Anthony Marsh has stated on more than one occasion, that it’s not if a terrorist attack occurs, but when. Given this expectation coupled with the fact that H + W EOC presents an extremely low risk terrorist target, why is anyone even considering axing this site?


Leamington Spa as a Support Site, however, has: -

Radio resilience cost effective
Staff use robust dispatch system and can provide training
Centre currently achieves new performance targets

How current is this? Have findings from the local work, referenced in point 10, into the examination of the systems that are currently in place been taken into consideration and made public?

Leased at a competitive rate

Until 2009 when lease expires.

5 The Leamington EOC also uses technology similar to that in place throughout the region e.g. telephony, vehicle tracking and mobile data. In essence, Leamington Spa is a high performing, high achieving EOC, that is meeting the new call connect targets whilst dealing with an increase in calls.

How current is this? Have findings from the local work, referenced in point 10, into the examination of the systems that are currently in place been taken into consideration and made public?

The Trust would also be able to save over £500,000 by not having to upgrade the equipment and make building changes to the current Bransford site thus providing this investment to improve front line operations e.g. Paramedics and ECPs.

This directly contradicts point 10 " Any money saved would be re-invested in the other EOCs so there is no cost saving involved".

What is the rationale for having 3 control centres?

A failure at one of the larger EOCs will affect the Trust’s ability to respond to emergencies – having a ‘buffer’ in the system would be beneficial in the event of a medium and long-term failure. Closure of too many Control Rooms over a short period could be destabilising.

So why limit to 3? Surely the fewer compounds the problem.

Why fix something that isn’t broken?

Currently, the Regional Trust is not safe from a resilience perspective. There is a clear need to implement common systems, such as CAD, AVLS, digital radio system and data communications, operational processes and procedures on a Regional basis. With a predicted call growth of between four and eight percent per annum the current situation does not provide adequate scope for expansion. Also the current fall back arrangements are unsafe.

H + W Ambulance control recognise the need to implement common systems but cannot accept that this has to be subject to the loss of control centres.

Bransford has a low staff turnover as opposed to the high turnover of MP staff.  Risk of knowledge and lower skill level.

Staff have been able to move on within the Brierley Hill EOC due to better career prospects within the Organisation.

Staff at Brierley Hill EOC have already moved on in anticipation of control staff from Hereford and Worcester EOC filling their vacant positions. Additionally, a post currently advertised at Leamington Spa states that applicants must be technician trained. This immediately rules out a possible transfer for any Hereford and Worcester EOC officer or any calltaker interested in further development. Are we to always expect vacancies to include such a clause?

The knowledge is passed from the experienced staff to new call takers throughout this period.

Metrics are misused!  The MP capacity utilisation rate is artificially high compared with Bransford.  In a nutshell we are comparing apples and pears.

I would be grateful if you could provide evidence of this all our figures are verified.

Communications have been poor.  They have heard rumours/innuendo about the proposed closure at the local supermarkets months ago.

Staff who are connected with the EOC Reconfiguration were informed of the draft proposals before they were made public.

This neither answers the question nor alters the fact that staff heard rumours/innuendo about the proposed closure at the local supermarkets months ago. Staff were informed only 1 working day before the proposals were made public that Bransford EOC was one of the ambulance controls that would not remain open. This is unacceptable timing. The proposals were made public before including Unison in the negotiations.


Decision is not fair. Staffordshire made all the noise and threats and got what they wanted.

Staffordshire is the second busiest locality in the Region, with Stafford EOC taking 300 calls per day/14 per hour compared to 211.9/8.8 respectively for Bransford. Staffordshire are also achieving their call connect targets.